ISSN:
1435-604X
Keywords:
Coronary angioplasty
;
Excimer laser
;
Light fluence rate distribution
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
,
Physics
,
Technology
Notes:
Abstract This paper reports on the initial clinical experience with 308 nm XeCl-excimer laser coronary angioplasty (ELCA) in the Academic Medical Center in Amsterdam and on calculations of light fluence rate distributions resulting from laser beams incident on tissue. Monte Carlo numerical computations were used to compute the light fluence rate distributions of a finite 308 nm excimer laser beam with various diameters incident on a liquid-tissue interface. It was found that light scattering is an important component in the resulting light distribution in aortic tissue. The calculations predict that there will be hardly any broadening of the beam outside the laser beam area. Therefore, the distributions from different fibres in multifibre catheters will not overlap unless the fibres are closely packed together. As a consequence of scattering the fluence rate at the surface of the tissue was larger than the incident power density and showed a considerable decrease from the centre to the edge of the beam. However, the physics of tissue ablation by fibres in contact with tissue are different and at present not well understood. The clinical results of the first 18 patients treated with the Dymer 200+ excimer laser (Advanced Interventional Systems, Irvine, CA, USA) are given. Six patients had abrupt closure solved by balloon angioplasty, but complicated by a small myocardial infarction. One patient had emergency by-pass surgery for abrupt closure after laser followed by balloon angioplasty (probably a dissection and thrombus). In one patient we perforated in a bend of a RCA with a 2.0 catheter following a second pass. We had two in hospital deaths (4 and 14 days after treatment). At 6 months follow-up, eight patients had restenosis or occlusion at the lased segment. However, the results of the first 1000 patients enrolled in the American ELCA-Registry are more promising. In the light of these results it can be concluded that a randomized trial balloon angioplasty versus excimer laser angioplasty appears to be indicated.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF02030881
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